Predictors of Mortality among Neonates with Congenital Diaphragmatic Hernia: Experience from an Inborn Unselected Cohort in India

Objective: To evaluate the clinical profile and predictors of mortality in neonates withcongenital diaphragmatic hernia (CDH). Method: Demographic and clinical parameters ofneonates with congenital diaphragmatic heria (n=37) between January 2014 and October,2017 were reviewed, and compared among those who survived or expired in hospital.Result: Median (range) gestation and birthweight were 38 (37-39) weeks and 2496 (2044-2889) g, respectively. Persistent pulmonary hypertension (PPHN) was documented in 19(51%) neonates and 10 (27%) had associated malformations. Surgery could be performed in18 (49%), overall mortality was 60%. On univariate analysis, low Apgar scores, presence ofmalformations, PPHN, need for higher initial peak inspiratory pressure/high frequencyventilation, and requirement of a patch for closure were associated with increased mortality.On multivariate analysis, PPHN remained the only significant risk factor [adjusted RR 3.74(95% CI 1.45-9.68)]. Conclusion: The survival of infants with CDH is low, and PPHN is animportant predictor of mortality.

Improving Duration of Kangaroo Mother Care in a Tertiary-care Neonatal Unit : A Quality Improvement Initiative

Objectives: To increase the duration of Kangaroo mother care(KMC) in preterm infants from an average of 3 hours/day to atleast 6 hours/day over 7 weeks through a Quality improvement(QI) approach in a tertiary-care neonatal unit.Methods: Preterm mother-infant dyads who were admitted in theNeonatal intensive care unit and KMC ward were enrolled in thisstudy. A QI team comprising of nurses, nurse educators, residentphysicians and nursing-in-charge of unit was formed. Thepotential barriers for prolonged KMC were evaluated using fishbone analysis. A variety of measures (allowing family membersincluding male members during night for doing KMC, makingKMC an integral part of treatment order, introducing the concept ofweekly KMC champions, etc.) were introduced and subsequentlytested by multiple Plan-do-study-act (PDSA) cycles. Data onduration of KMC per day was measured by bedside nurses ondaily basis.Results: 20 eligible mother-infant dyads were studied duringimplementation period (50 d). The mean (SD) weight andgestation of infants were 1199 (356) g and 31.1 ( 2.3) wks,respectively. We achieved our goal by step-wise implementationof changes through construction of 3 PDSA cycles. The durationof KMC increased to 6 hours-a-day over a period of 7 weeks.Evaluation at 6 and 12 months in the post-implementation phasesuggested sustenance of improved KMC duration up to 9 h/day inthe unit.Conclusions: Ongoing quality improvement measures increasedthe duration of KMC from a baseline of 3 h to 6 h in eligible preterminfants, and the results were sustained at 6-12 month.